Fracture principles Flashcards
Causes of pathological #
abnormal bone, normal stress (OMIT) Osteopenia/ osteoporosis Metabolic bone dz (hyperPTH, hyperthyroid, osteoporosis, osteogenes imperfecta, rickets) Infection Tumour
Metaphyseal vs diaphyseal #
Meta #:
healing rapid, by ingrowth, movement little
Diaph#:
lots of movement, healing by callus
Mgx of ligamentous injuries
range: sprain, strain, tear
Mgx:
conservative - splint > physioT > functional brace
OR sx reconstruction
Stable # definition
&
Post reduction acceptability criteria
stable #: upon reduction, # remains reduced with simple splintage (x ray) and normal mvt (>50% of normal range)
Post red criteria (adults)
- bone union >50% of bone contact
- angulation <20deg for long bones
Purpose of splinting
- Alleviate pain
- Ensure union takes place in good position
- Permit early movement and return to function
Deg of # repair
union vs consolidation
Union: incomplete repair
- # line visible
- ensheathing callus calcified
- fracture site tender
Consolidation: complete repair
- # line crossed by trabeculae, non visible
- calcified callus ossified
- # site non tender to palpation or angulation stress
Cx of #
LOCAL (Early) - soft tissue injury: nerves, vessels, visceral - swelling: compartment syndrome, hemearthrosis - info: gas gangrene, OM (Late) - union: delayed, malunion, non union - AVN - growth disturbance - joint: instability, OA, stiffness - complex regional pain syndrome - soft tissue: heterotrophic ossification, muscle contracture, tendon rupture, nerve compression/ entrapment
SYSTEMIC
- fat embolism
- hemorrhagic shock
- ARDS, MODS
- DVT/ PE
- sepsis
Principles of management of #
FRIAR first aid: ABC, preliminary skin traction reduction immobilisation active rehabilitation
Indications for # fixation
- To save life or limb
- To reconstruct displaced articular fractures
- To prevent deformity
- To promote union when it is delayed
- Improved function following early motion
CI to open reduction
- severe osteoporosis
- active infection or osteomyelitis
- severe comminution that cannot be reduced
- severe soft injury
- poor general condition
- nondisplaced fracture
Indications for open reduction
NO CAST N - non union O - open fracture C - neurovasc compromise A - intra-articular # S - salter Harris 3-4-5 T - poly trauma
others:
- failed closed reduction
- avulsion # (held apart by muscle pull)
- pathological #
- int fixation needed (unstable #) or will allow for better function
- infection
- unable to maintain reduction state
Stabilisation of #
- principles of # fixation
- types of stabilisation
Principles: translational stability + rotational stability + axial stability
Types: External fixation - splints, tape - casts - traction - external fixator Internal fixation - percutaneous pinning (K wires) - extra medullary fixation (screw, plate, wire) - intramedullary fixation (rods)
4 principles of traction
- line of pull in alignment with long axis of bone
- continuous traction maintained
- no interruption with line of pull
- adequate counter traction
Cx of traction
- Circulatory embarrassment
- Nerve injury (Common peroneal palsy)
- Skin: Pin-site infection (steinmenn pin), blisters, ulcers, pressure sores
- Problems with immobilization: DVT, pneumonia, bed sores, UTI
- Loosening of Steinmann pin
- Ring pressure (Thomas’s splint)
Principles of cast splintage
- One joint above and below the #
- Cast is well molded with no pressure points
- Padding at bony prominences
- Backslab instead of full cast in acute setting
- Elevation to prevent swelling
- All hand fractures have a standard functional hand position cast
